Ask The Dentist #2: Baby teeth and extractions

Posted Feb 16th, 2017

Ask The Dentist is a series of columns written by Dr. Mady to answer your questions about dentistry and oral health!

Dear Dr. Mady: My six year old boy has a lot of baby teeth with cavities and our dentist wants to repair them. I feel that they should just be pulled out because in a few years they are going to fall out anyway. Is this a wise decision for me to make? Fixing them costs too much and he is afraid of the dentist anyway. - Pauline

Dear Pauline: This is not a wise choice. Extracting baby teeth early, unless totally necessary, can lead to a multitude of problems and the permanent teeth will usually be affected. Preserving these deciduous or primary teeth is very important.

There are many instances in my practice where child patients have presented with problems related to decay or trauma. I made every attempt to save these teeth for them for various reasons. These included maintenance of space and proper function. Treatment however is dependent on factors such as age and dental age of the child, location and condition of the teeth in question, and the cooperation of the patient. If a child is apprehensive and uncooperative, this actually could affect the treatment plan.

If after evaluation, the tooth or teeth are found to have such advanced caries (decay) that they are non-restorable, then extraction is a good treatment option. Also, if this is the case, space maintenance should be contemplated especially if a primary molar is lost or going to be removed. This can usually be accomplished by an orthodontic device known as a space maintainer. It can be fabricated in many different ways. If this space is not maintained, then the teeth immediately behind and in front of the extracted tooth may drift into the space. If this occurs, then it could inhibit the eruption pattern of the permanent tooth that will be replacing the missing one and malocclusion may result.

If on the other hand, the tooth structure lost is not severely extensive, restorative options should always be considered. These include restorations such as fillings or stainless steel crowns. Often moderately decayed deciduous teeth will require a pulpotomy prior to restorative treatment where the coronal pulp or nerve and blood tissue in the top part of the tooth near the biting surface is removed first. It is sort of like a baby tooth root canal, but not as complex a procedure. If both the coronal and root sections of pulp need to be removed, the procedure is known as a pulpectomy.

The success rate of pulpotomies varies usually in the range of 65-to-98%. If this does not solve the problem, then extraction is usually indicated and space maintenance can be addressed. If you are lucky, most of these teeth will be in need of fillings only.

If cooperation is a problem you may want to request a referral to a pediatric dental specialist who can sedate your child or use general anesthesia. The possibility of an otherwise unpleasant experience could cause a life long dental phobia. The most important rule to remember is to save teeth whenever possible whether adult or child. If finances are a problem, consult your local health unit and see what assistance programs are available.

- Dr. David Mady

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